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MIDWEST FAMILY HEALTH OF SMITH CENTER, L
CAH171377-00 Great Plains of Smith County, dba Smith County Memorial Hospital
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Covered Entity Details
Entity Name
Great Plains of Smith County, dba Smith County Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171377-00
Entity Address
921 E. Highway 36
Smith Center, KS 66967
Medicare Provider Number
171377
Participating Start Date
7/1/2014
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
MIDWEST FAMILY HEALTH OF SMITH CENTER, L
Pharmacy Address
317 E HIGHWAY 36
SMITH CENTER, KS 66967-9586
Pharmacy Comments
Contract Details
Approval Date
12/9/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Allen Van Driel, Chief Executive Officer
(785) 282-6845
Contract Pharmacy Representative
Robert Wenzl, Owner
(785) 543-5131
Signed By Date
12/9/2014
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